Better Vision. Better Hearing. Better Georgia.

Hearing Services Application

The Lighthouse's hearing services include a digital hearing aid and four follow-up visits.  The Lighthouse does not cover the initial exam by an audiologist.  If you would like to have a hearing test performed, please contact one of our partner audiologists.  A list of partner audiologists by city can be found here.

Please note, every step must be completed in order for you to submit your application online. If you cannot scan your documents, or you do not have all of the necessary documentation at this time, you may also print off and mail your application. Simply download the application in Step 1, fill it out, and mail it with the supporting documentation to

Georgia Lions Lighthouse Foundation
Hearing Services
5582 Peachtree Road

Atlanta, GA 30341

Step 1: Download an application

Hearing Services Application

Step 2: Fill out the application
Two pages of the application (the Audiologist/Dispenser Recommendation and the Medical Information) must be completed by an audiologist.  After they are filled out, you can scan them in and attach them in Step 4).




Step 4: Attach your Audiologist/Dispenser Recommendation and Medical Information Form

These forms can be found in the application you downloaded.  They must be filled out by a doctor and scanned in order to be submitted online.  If you cannot scan your documents please mail your application along with the supporting documents.





Step 5: Attach a copy of your Georgia Medicaid Card

If you do not receive Medicaid, please skip to Step 6.





Step 6: Please attach proof of Georgia Residency
You can prove Georgia residency using one of the following: 
1. A Lease Contract (if renting)
2. A Mortgage Statement (if you own your home)
3. Referral from a shelter or transitional home, or
4. Referral from a nursing home.





Step 7: Please provide proof of Income
Household income must include all persons residing at the applicant's address.  Please provide the following information for everyone living at the applicant's address: 
Last year's tax return and any of the following that apply
1. Three current pay check stubs
2. Social Security Administration Award Letter
3. Food Stamp Papers from Family & Children Services (award summary notification)
4. Unemployemnt claim, if unemployed - wage inquiry statement from GA Department of Labor
5. Information indicating the applicant is receiving TANF, Social Security Disability, Pension, Retirement, Veterans dministration Benefits, or any other sources of income
6. Last three months of bank statements and/or
7. Letter from nursing home stating income benefits.

Please scan all documents into one file and attach it below. 





Step 8: Please provide the results of your hearing test
Please contact the Lighthouse for a list of providers in your area.  The hearing test may not be older than six months.  The Lighthosue does not pay for hearing tests.  Medicaid and Medicare may or may not cover an annual hearing exam.